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Information from Your Family Doctor

How to Take Your Medicines for HIV

Am Fam Physician. 2003 Aug 15;68(4):689-690.

What should I know about my HIV medicines?

Combinations of medicines that are used to fight human immunodeficiency virus (HIV, for short) are called ART. This stands for antiretroviral therapy (say: “an-tee-ret-ro-vi-rull”). If you have HIV, ART will not cure you, but it can help you fight off infections and live a longer life.

HIV attacks your body by entering cells and copying itself. As the amount of virus in your body (called the viral load) increases, you get sick. ART helps you feel better by blocking the chemicals that HIV needs to copy itself. The lower your viral load, the longer you can stay healthy.

The goal of therapy is to get your viral load so low that it can't be measured by blood tests. But it is important to remember that even when your viral load is this low, you can still infect other people with HIV.

Why is it so important to take my medicine correctly?

ART can work very well if you take the medicines the right way. But if you don't take your medicines just the way your doctor tells you to, your HIV might not be exposed to enough medicine to control it. If this happens, the HIV becomes resistant, and the medicines you were taking stop working. Resistance to ART medicines may last forever.

There are not many kinds of medicine that can be used to treat HIV. So if you don't take your medicines the right way and your HIV becomes resistant, you can run out of ways to treat your infection.

What if I forget to take my pills?

There are many pills involved with ART, and you often need to take them at different times of the day. It can be hard to remember, but you must take at least 95 percent of your pills. For example, if your doctor has prescribed 15 pills per day, you can miss no more than five pills per week.

Some people put their pills in a daily pillbox and use alarms to remind themselves to take their medicines.

Do I have to eat or drink something when I take my pills?

Some medicines must be taken with meals, and others must be taken on an empty stomach. The box below shows some ART medicines and whether they should be taken with food or without food. Check with your doctor and pharmacist about your particular medicines.

Some people who take indinavir get kidney stones. If your doctor wants you to take this medicine, you should drink at least 10 cups of water per day to help prevent kidney stones.

Take with food

Tenofovir (brand name: Viread)

Ritonavir (brand name: Norvir)

Saquinavir (brand name: Fortovase)

Lopinavir plus ritonavir (brand name: Kaletra)

Nelfinavir (brand name: Viracept)

Take on an empty stomach (one hour before or two hours after eating)

Didanosine (brand name: Videx)

Efavirenz (brand name: Sustiva)

Indinavir (brand name: Crixivan)

If you take nelfinavir, acidic foods and drinks like orange juice, apple juice, or applesauce will taste very bitter if you eat or drink them at the same time you take your medicine.

If you like to drink grapefruit juice, ask your doctor about it, because it can affect some medicines. And ask your doctor if it's safe for you to have alcoholic drinks.

Lopinavir, ritonavir, and saquinavir should be kept in the refrigerator. If they are kept at room temperature, they become weak after a month or two.

What are some of the more serious side effects of my medicines?

ART can increase cholesterol levels and cause you to gain fat in your upper back, neck, chest, and stomach. When these conditions are caused by genetics or by eating the wrong kinds of food, they are bad for you. But doctors do not know yet if they are as bad for you when they are caused by ART.

ART can weaken your bones, especially the bones in your hips. ART can worsen diabetes and a bleeding disorder called hemophilia (say: “he-mo-feel-ee-ah”). ART can cause liver failure, kidney failure, nerve damage, and severe allergic reactions. Serious reactions usually happen in the first few weeks of therapy.

You should tell your doctor if you have any of the following symptoms:

Constant thirst or frequent need to urinate

Fever, rash, or stomach problems

Long-lasting groin pain (the groin is the area between the belly and the thigh)

Weakness, diarrhea, or a bloated feeling

Pain in the middle of your stomach, especially pain that gets worse after eating.

Even when you are feeling well, your doctor might do laboratory tests to make sure you are not having side effects from your medicine.

Is it safe to take ART with other medicines or herbal medicines?

Tell your doctor about every other medicine you take. This means prescription medicines, over-the-counter medicines, and herbal products. ART can be dangerous if you take it with some medicines or herbs. These include medicines for high cholesterol, heart or blood problems, tuberculosis infection, migraine headaches, anxiety, and insomnia.

Some prescription medicines and herbal products can make your body push the ART medicines through too fast, before they have time to work. Medicines for seizures and some kinds of infections might do this. St. John's wort, which some people use to treat depression, and garlic pills can make the level of ART in your body drop too low to be helpful.